registered nurse Remote
Job description
2+ Years Managed Care (Health Insurance Company) Experience is a MUST.
The Utilization Management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
Job Duties and Responsibilities:
Utilization Management:
· Concurrent review of patient’s clinical information for medical necessity
· Pre-certification requests for medical necessity
· Coordinates patient’s discharge planning needs with the healthcare team
· Employ effective use of clinical knowledge, critical thinking, and evaluation skills
· Maintain accurate records in the designated medical management system
· Ability to stay organized and interact well with others
· Provide updates to Manager of Utilization Management
Skills and Qualifications:
· North Carolina licensure as a Registered Nurse (RN)
· Minimum 2 years of prior experience in Health Insurance Company Utilization Management
· Extensive history of using InterQual Criteria
· Strong knowledge of word processing and working with care management platforms or spreadsheet computer programs
· History of working in "critical thinking roles" - prior ER/ICU/Med Surg experience desired
· Utilization Management certification preferred for UM nurses
Job Types: Full-time, Contract
Pay: From $45.00 per hour
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- Managed Care (Health Insurance): 2 years (Required)
- InterQual: 1 year (Required)
License/Certification:
- North Carolina Nursing License (RN) (Required)
Work Location: Remote
